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General NPI Number Information
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NPI Number | 1194514034
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY FAMILY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1220 COFFEEN ST BLDG 17
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City | WATERTOWN
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State | NY
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Zip | 13601-1822
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Country | US
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Telephone | 315-782-9450
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Fax |
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Provider Business Mailing Address
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Address Line | 238 ARSENAL ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2504
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Country | US
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Telephone | 315-782-9450
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICIER
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Name | JOEY M HORTON
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Credential |
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Telephone | 315-782-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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